Form Of Pain Relief Research Articles

Management of Spinal Metastasis by Minimally Invasive Surgical Techniques: Surgical Principles and Indications-A Literature Review.

Spinal metastasis is becoming more frequent. This raises the topics of pain and neurological complications, which worsen the functional and survival prognosis of oncological population patients. Surgical treatment must be as complete as possible in order to decompress and stabilize without delaying the management of the oncological disease. Minimally invasive spine surgical techniques inflict less damage on the musculocutaneous plan than opened ones. Different minimally invasive techniques are proposed in this paper for the management of spinal metastasis. We used our experience, developed degenerative and traumatic pathologies, and referred to many authors, establishing a narrative review of our local practice. Forty-eight articles were selected, and these allowed us to describe the different techniques: percutaneous methods such as vertebro/kyphoplasty, osteosynthesis, mini-open surgery, or that through a posterior or anterior approach. Also, some studies detail the contribution of new technologies, such as intraoperative CT scan and robotic assistance. It seems essential to offer a lasting solution to a spinal problem, such as in the form of pain relief, stabilization, and decompression. Our department has embraced a multidisciplinary and multidimensional approach to MISS, incorporating cutting-edge technologies and evidence-based practices.

Retrospective study to assess the effect of epidural analgesia on labor progress and women’s pelvic floor muscle from the perspective of electromyography

Objective Epidural analgesia has been widely used as a form of pain relief during labor and its safety has been gradually recognized. However, few studies of the effect of epidural analgesia on the pelvic floor are known. Thus, we aim to analyze the effect of epidural analgesia on labor progress and women’s pelvic floor muscle from the perspective of electromyography systematically. In addition, obstetric risk factors for dysfunction of pelvic floor muscle after vaginal delivery were also evaluated. Methods Childbirth data of 124 primiparas who gave first birth vaginally in our hospital and their pelvic floor function assessment results at postpartum 7 weeks were retrospectively collected. Pelvic floor muscle electromyogram screenings were performed by a biofeedback electro-stimulant therapy instrument. Results There was no significant difference in the percentage of episiotomy, forceps, artificial rupturing membrane, and the application of oxytocin, except perineal laceration. Woman who implemented epidural analgesia experienced a longer stage of labor. Statistically, there was no significant difference in the total score and pelvic floor muscle strength. The risk factors for the value of the pre-rest phase include the age of pregnant women, the fetal weight, and the length of the second stage while the value of the post-rest phase was only associated with the fetal weight and the length of the second stage. In addition, the value of type I muscles was associated with the gravida and fetal weight while the value of type II muscles was only associated with forceps. The sustained contraction was correlated with the gravida and the total scores had a significant correlation with forceps. Conclusion Epidural analgesia during labor is approved to be a safe and effective procedure to relieve pain with very low side effects on the mode of labor and pelvic floor muscle. The assessment of pelvic floor muscle before pregnancy is beneficial in guiding the better protection of pelvic floor muscle function. According to the evaluation results, the doctors can control the associated risk factors as much as possible to reduce the injury of pregnancy and parturition to the pelvic floor.

Nerve blocks on forelimbs and hindlimbs as part of a multimodal analgesia plan

Using local blocks in conjunction with other forms of pain relief have been shown to reduce the length of hospital stays and postoperative recovery times in human patients. This article will explain common hindlimb and forelimb local blocks using electrostimulation for the correct location of the nerve to provide superior pain relief in small animals when used as part of a multimodal analgesic plan.

Should remifentanil patient-controlled analgesia be a routine choice for pain relief in labour?

Patient-controlled analgesia with remifentanil is usually reserved for patients for whom other forms of pain relief are contraindicated. However, remifentanil patient-controlled analgesia reduces the likelihood of needing an epidural and therefore the risk associated with it, provides good pain relief compared to other options, and the risks can be mitigated with appropriate management.

Awareness among Pregnant Women about Epidural Analgesia: A Cross-Sectional Study.

Background Epidural analgesia (EPA) is an effective anesthetic technique to overcome pain during labor. This study aimed to evaluate the current awareness of EPA among pregnant women. Methods We carried out a cross-sectional study using a questionnaire to measure awareness about EPA among pregnant women visiting the obstetrics and gynaecology clinic in King Abdulaziz Medical City in Jeddah. Following the results, a group of women was selected and educated by trained medical students. Results This study comprised 105 women. We found that 25 (23.8%) respondents revealed a complete lack of knowledge regarding EPA, 63 (60%) showed minimal awareness, and 17 (16.2%) were aware of EPA from various sources. The gravidity and history of EPA administration were significantly associated with knowledge. Multigravida women and those who had received EPA showed higher level of knowledge (p=0.048 and p < 0.001, respectively). In addition, there was a significant association between the level of education and request for EPA (p=0.027). Forty-one participants were enrolled in an educational program that explained the importance of EPA. Twenty (48.8%) women decided to undergo EPA during delivery; however, 7 (17.7%) refused and 14 (34.1%) were not sure about their decision. Conclusion This study revealed a lack of awareness about EPA among pregnant women. Educational programs were effective as many participants chose EPA following the educational session as a form of pain relief during labor. We recommend the implementation of routine education on EPA in vaginal delivery during antenatal visits for all pregnant women.

A retrospective analysis of complex proximal humerus fractures managed with reverse shoulder arthroplasty in a level 1 trauma center

BackgroundThe treatment of complex 3- and 4-part proximal humerus fractures (PHFs) in the elderly poses significant challenges because of osteoporosis and fracture comminution. The wide range of surgical options available is evidence of the complex nature of the injury. At present, reverse shoulder replacement is gaining popularity among shoulder surgeons for treating these difficult fractures, and the literature has shown equivalent or superior outcomes with reverse shoulder arthroplasty (RSA). We aimed to analyze the long-term results of these complex PHF treated with reverse shoulder replacement. MethodsFor this study, fractures from 39 patients with a mean age of 63.18 years who were treated with RSA for acute complex fractures of the proximal humerus in our institution between 2013 and 2019 were analyzed (n = 31, acute 4-part fractures; n = 4, acute fracture–dislocation; n = 3, fracture with irreparable cuff tear; n = 1, osteoporotic 2-part fracture). All patients had a standard reverse shoulder replacement (cemented humeral stem n = 37 and uncemented stem n = 2) surgery in a level 1 trauma center. The mean follow-up duration was 60 months (24-111 months). The clinical outcomes (Oxford Shoulder Score and Constant Shoulder Score) and the complications at 6 months, 12 months, and 24 months were analyzed. ResultsOur study found a relatively younger population, with 21 patients (53.84%) aged <66 years. Spearman's correlation showed that younger patients had better signs of improvement in Oxford Shoulder Scores at 2 years (P = .008). The average Oxford Shoulder Score was 39.12 ± 4.327, and the average Constant Shoulder Score was 67.67 on the operated side. The mean active forward elevation was 142.56 ± 22.29º, abduction was 136.538 ± 24.31º, external rotation was 27 ± 9.011º, and internal rotation was 33 ± 20.41º. The overall complication rate of 17.94% (periprosthetic infection n = 2, periprosthetic humerus fracture n = 1, and hematoma evacuation n = 4) in our study was similar to those of recent studies in the literature. ConclusionRSA provides a reliable option for PHFs and offers good results in the form of pain relief and good functional outcomes at 2 years even in a younger age group. Thus, it is fast becoming an important option in treating complex PHF, but we must be wary of the steep learning curve and the complications pertinent to this procedure.

Intrapartum Analgesia-Have Women's Preferences Changed over the Last Decade?

Background: Global access to social media has supposedly changed women’s awareness about the pharmacological and alternative methods of pain relief during vaginal delivery. The purpose of the study was to analyze changes in women’s preference and opinion about different forms of labor analgesia over the past decade. Materials and methods: The study was designed as an anonymous survey with questions about women’s knowledge and preference of different forms of pain relief in labor. The survey was conducted in 2010 and 2020, with data collected from 1175 women in 2010 and 1033 in 2020. Results: There were no differences between 2010 and 2020 in the proportion of women who wanted to receive analgesia in labor, at, respectively 67.9% of women in 2010 and 73.9% in 2020. About 50% of women chose epidural analgesia as the only efficacious method of pain relief in labor both in 2010 and 2020. There were no differences between the two time-points in the distribution of chosen methods of pain relief. In total, 92.3% of women in 2010 and 94.9% in 2020 thought that they should have the possibility of independent choice of analgesia method before the delivery (p < 0.04). Conclusions: A high proportion of Polish women choose EDA over other pharmacological and nonpharmacological methods of pain relief in labor, and this preference has not changed over the last decade. Increasing women’s knowledge about different methods of intrapartum pain relief may lead to wider use of nonpharmacological methods of pain relief.

AN OBSERVATIONAL STUDY TO COMPARE THE EFFICACY OF ROPIVACAINE ALONE AND ROPIVACAINE WITH DEXMEDETOMIDINE IN ULTRASOUND GUIDED FASCIA ILIACA COMPARTMENT BLOCK FOR ANALGESIA IN POSITIONING OF THE PATIENT IN SUBARACHNOID BLOCK PERFORMED IN UNILATERAL FEMUR FRACTURE SURGERY

Introduction: Patients encountered with fracture shaft and neck femur require some anaesthesia or pain relief to allow radiological, orthopedic and other procedures to be performed. Regional anaesthesia is the most widely used an aesthetic technique for orthopedic procedures in lower limbs.Fascia iliaca blocks provide a safe, cheap and effective form of pain relief for patients with neck of femur fractures. Animal studies have proven the combination of dexmedetomidine with ropivacaine to be safe and neuro-protective. Fascia iliaca compartment block which involve femoral nerve, lateral cutaneous nerve of thigh and obturator nerve. This study is designed to compare Fascia Iliaca Compartment Block under ultrasound guidance with ropivacaine and ropivacaine plus dexmedetomidine positioning during spinal anesthesia in femur fractures. Material and methods: This study was conducted at Mahatma Gandhi hospital and Mathuradas Mathur hospital, Jodhpur during January 2019–January 2020. 60 Patients admitted in Orthopaedic ward age group 21-60 yrs. of both sex were the source of data. Patients undergoing elective surgery for fracture femur (neck of femur and intertrochanteric) under SAB were included in the study. We divided the cases into 2 groups of 30 each, as GROUP R: Patients were received 30 ml 0.50% Inj. ropivacaine + 2 ml Normal saline with a total volume of 32 ml in unilateral FICB. GROUP RD: Patients were received 30 ml 0.50% Inj. Ropivacaine + 2 ml Inj. Dexmeditomidine (0.5mcg/Kg) with a total volume of 32 ml in unilateral FICB. Standard protocol followed to administering regional anaesthesia. All data were collected and analysed with the help of suitable statistical parameters. Results: Our study results in that Fascia Iliaca Compartment Block with combination of ropivacaine and dexmedetomidine is more efficacious than ropivacaine alone for positioning during spinal anaesthesia in surgery for fracture femur. Key words: Spinal Anaesthesia, Fascia Iliaca Compartment Block, Ropivacaine, Dexmedetomidine.

The outcome of carpal tunnel syndrome with modified mini-incision technique.

Background: Median nerve compression in hand at the level of transverse ligament leads to numbness and pain in the hands, which results in discomfort in daily routine work has a psychological impact. The objective of the present study was to evaluate the modified mini-incision at the transverse crease in carpal tunnel syndrome.&#x0D; Methodology: A prospective descriptive study was conducted at Neurospinal &amp; cancer care Institute, Karachi, from January 2012 – February 2020. Patients who were diagnosed with clinical symptoms, positive Phalen and Tinel test and confirmed with EMG finding of carpal tunnel syndrome were included in the study. Patients were operated through modified mini-incision at the transverse crease. The outcome was recorded in the form of pain relief, healing time with restoration of daily life activity and scar adhesion on follow-up.&#x0D; Results: A total of 97 patients were included. The male to female ratio was 1:7.8. The mean age was 40 ± 19.5 years. The right hand was 72.2%, the left hand was 13.4%, and the bilateral was 14.4%. VAS score improved 2 grades in 96%, and pinch grip improved in 98% of patients in one month. Only 2% of patients had stiffness after surgery&#x0D; Conclusion: Minimal incision carpal tunnel release has shown positive outcome in median nerve compression, having limited skin incision, safe, feasible and minimizing the scar assist help in early return to work.

Arthroscopic Management of Resistant Lateral Epicondylitis

Lateral epicondylitis treatment is still controversial, most of patients managed with conservative measures including rest, NSAIDs and physiotherapy. However, some of them do not respond well and have to be managed surgically. That can be done either open or arthroscopic technique. The aim is to study the technique and functional outcome of arthroscopic management of lateral epicondylitis. Prospective study. Between December 2016 and July 2019, 26 (16 female and 10 male) patients aged (28-57) presented with resistant lateral epicondylitis treated with elbow arthroscopy. Functional assessment preoperative and postoperative using VAS and Mayo score was done to all patients. The study included patients with elbow pain and weak grip symptoms with failure of conservative treatment for at least 6 months excluding revision, infected, rheumatoid arthritis patients, and previous steroid injection in past 3 weeks. The mean operative time was 65 minutes; the mean follow-up time was 20.3 months. The patients were reintegrated into their activities at 21 days postoperatively. Pain as a sign and capital symptom improved significantly within 12 days of surgery. Mayo score improved postoperatively. The Mean ± SD preoperative Mayo score was 59.5 ± 7.23 and to 96.5 ± 3.03 after follow up for six months. The Mean ± SD preoperative VAS score was 8.9 ± 0.76 and raised to 0.84 ± 0.74 and to 0.5 ± 0.5 after follow up for six months (Table 2). All patients were satisfied because of small wound size with cosmetic suture, rapid return of movement of elbow after operation and rapid improvement of pain level. One patient developed transient forearm neuropraxia that resolved within three weeks with neurotonics. Short-term evaluation of arthroscopic release of resistant lateral epicondylitis gives good functional outcome in the form of pain relief, patient satisfaction, and low complication rate. Die Behandlung von Epicondylitis humeri radialis wird nach wie vor kontrovers diskutiert. Beim Großteil der Patienten führten konservative Maßnahmen wie Ruhe, NSAIDs und Physiotherapie zu Verbesserungen. Für einige Patienten führen diese Maßnahmen allerdings nicht zum gewünschten Ergebnis, sodass ein chirurgischer Eingriff notwendig wird, der entweder offen oder arthroskopisch durchgeführt werden kann. Ziel dieser Arbeit ist die Untersuchung von Technik und funktionellen Ergebnissen der arthroskopischen Behandlung von Epicondylitis humeri radialis. Prospektive Studie. Zwischen Dezember 2016 und Juli 2019 stellten sich 26 Patienten (16 weiblich, 10 männlich im Alter zwischen 28 und 57 Jahren) mit chronischer Epicondylitis humeri radialis, die mittels Ellenbogenarthroskopie behandelt worden waren, vor. Allen Patienten wurde eine visuelle Analogskala (VAS) zur Bewertung der prä- und postoperativen Funktion sowie zur Bestimmung des Mayo-Scores vorgelegt. Patienten mit den Symptomen Ellenbogenschmerzen und Griffschwäche sowie einer seit mindestens 6 Monaten andauernden, erfolglosen konservativen Therapie wurden in die Studie eingeschlossen. Ausgeschlossen wurden Patienten mit sich bessernden Symptomen, Infektionen, rheumatischer Arthritis oder einer weniger als 3 Wochen zurückliegenden Steroid-Injektion. Die durchschnittliche Operationszeit lag bei 65 Minuten. Die Nachbeobachtungszeit lag im Mittel bei 20,3 Monaten. 21 Tage nach dem Eingriff nahmen die Patienten ihre gewohnten Aktivitäten wieder auf. Das Hauptsymptom Schmerz verbesserte sich innerhalb von 12 Tagen nach der Operation signifikant. Der Mayo-Score verbesserte sich postoperativ. Der Mayo-Score (Mittelwert ± Standardabweichung) lag präoperativ bei 59.5 ± 7.23 und lag nach 6 Monaten Nachbeobachtung bei 96.5 ± 3.03. Der mittels VAS gemessene Wert (Mittelwert ± Standardabweichung) lag bei 8.9 ± 0.76 und reduzierte sich auf 0.84 ± 0.74 bzw. auf 0.5 ± 0.5 nach sechsmonatiger Nachbeobachtungszeit (Tabelle 2). Alle Patienten zeigten sich zufrieden mit der geringen Wundgröße mit kosmetischer Naht, der schnellen Rückkehr zur Ellenbogen-Beweglichkeit nach der Operation sowie mit dem schnellen Absinken des Schmerzniveaus. Ein Patient entwickelte eine vorübergehende Neurapraxie des Unterarms, die unter Einsatz von Neurotonika innerhalb von 3 Wochen wieder abklang. Kurzzeitbewertung der arthroskopischen Freisetzung resistenter lateraler Epicondylitis führt zu einem guten funktionellen Ergebnis in Form einer Schmerzlinderung, Patient Zufriedenheit und niedrige Komplikationsrate.

Effect of TENS on Post-operative Sternal Pain (Post Cardiac Surgery): A Narrative Review

Transcutaneous electrical nerve stimulation TENS is a modality that blocks the pain by pain gate mechanism and is documented to be safe and effective. Sternum pain signifies the pain in the thoracic cavity that contains the sternum and the cartilage connecting it to the ribs. Patients who experience pain after any cardiac surgery may also experience prolonged immobilization insufficient respiratory functions and the inability to cough as a result of the surgical procedure specifically post median sternotomy. TENS has been shown to be effective in acute and chronic pain in both medical and surgical conditions in multiple studies conducted since 1970. This review was conducted to document the effectiveness and also the parameters of TENS used post Coronary Artery Bypass Graft CABG to relieve pain and improve parameters like functional capacity cardiopulmonary endurance length of hospital stay etc. The review concluded that many studies documented the effectiveness in post-operative CABG patients however some studies stated that it was less effective than other forms of pain relief. The parameters of TENS used in all the randomised control trials have been documented in the results.The clinical application of this review is that TENS can be used as an adjunct treatment in post-operative sternal pain patients on an inpatient and outpatient basis which will be working on other parameters functional capacity cardiopulmonary endurance length of hospital stay apart from pain relief and eventually helps in improving the quality of life of the patients.

Influence of myofascial therapy on painful erection – case study

Pain during sexual intercourse in men is a well-recognized symptom that is considered in the context of sexual dysfunction. Because there is no clear definition, it can be a joint feature of chronic prostatitis, chronic pelvic pain syndrome (CPPS), or come from connective tissue. Because of the many possible causes of genitourinary pain, a multimodal approach is necessary. The aim of this study is to present the effect of myofascial therapy on chronic, unpleasant, dull pain at the level of VAS = 9, occurring during erection and ejaculation, as well as during touch of the testicle in a 35-year-old man. The patient did not have erection problems, which was confirmed by an accurate and reliable tool in the form of the International Index of Erectile Function (IIEF-5). The man received two myofascial therapies, 45 min. each, 7 days apart followed by significant improvement in pain relief (VAS = 0). The manual techniques were used to find and remove changes manifested by increased muscle tone and fascia, lack of displacement of structures relative to each other, maximum painful points, and trigger points. In the follow-up examination performed after 1, 3 and 6 months, the patient confirmed that the effects of therapy were maintained. Connective tissue may play an important role in the occurrence of genitourinary pain. Physiotherapeutic examination and usage of myofascial techniques can bring beneficial effects in the form of pain relief in the relevant region.

Relief of pain due to uterine cramping/involution after birth.

Relief of pain due to uterine cramping/involution after birth.

Knowledge Awareness and Attitude of Women toward Epidural Anesthesia during Labor

Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labor. However, it is likely that epidural blocks lengthen labor and result in increased rates of operative vaginal delivery. Although, questions have been raised about its side effects.&#x0D; Objectives: The aims of this research study are; to predict the common use of epidural analgesia in Palestinian women, to assess its effectiveness on pain relief, and to determine its adverse effects. However, the study designed to measure the knowledge awareness, and attitude of Palestinian women toward epidural anesthesia during labor.&#x0D; Methods: A cross-sectional study was conducted using an online questionnaire. The study included females (age &lt; 20 - &gt; 40 years old) from all governorates in Palestine. The survey was designed to measure the knowledge awareness and attitude of Palestinian women toward epidural anesthesia during labor. A total of 2685 females participated in the study. SPSS version 22 was used to analyze the data collected.&#x0D; Results: About 893 women (33%) participated in the research study didn’t use the epidural analgesia and 1792 (67%) women used it, out of 2685 women completed the questionnaire. The research study included Palestinian women in different Governorates in Palestine. 43.2 % (800) of women who participated in this research study mentioned that the epidural injection is painless, 29.3% (543) said that it is painful and others filled it may be painful. In women used epidural injection, the expending of uterus was 1-2 cm in 355 women (20.5%), 2-3 cm in 325 women (18.7%), 3-4 cm in 482 women (27.8 %), 4-5 cm in 355 women (20.5%) and more than 5 cm in 218 women (12.6 %). The percentage of birth pain which anesthetized by epidural analgesia; 621 women (35%) mentioned that the epidural injection anesthetized about 80-100% , 24.5% (434) is 60-80% ,13% (230) is 40-60% , 9.4 (166) is 20-40% and 18.2% (322) is 0-20% . &#x0D;

Complementary and alternative therapies for post-caesarean pain.

Complementary and alternative therapies for post-caesarean pain.

Improving labour progression among women with epidural anesthesia following use of a birthing ball: a review of recent literature

Epidural anaesthesia is an effective form of pain relief during vaginal deliveries. However, neuraxial anaesthesia may slow the progression of labour. The assumption that epidurals lead to increased caesarean sections is also a topic of current debate. A holistic approach with the use of a birthing ball has been advocated as a potential modality to decrease labouring times and, therefore, reduce progression to caesarean section. Birthing balls aim to increase pelvic outlet opening, which facilitates labouring. Our aim is to review recent literature pertaining to birthing balls and their role in improving quality and outcomes of vaginal deliveries in patients with epidurals.IMPACT STATEMENTWhat is already known on the subject? Epidural anaesthesia may slow the progression of labour. It has been hypothesised that slowing progression of labour is associated with increased rates of vacuum and forceps delivery. Most common clinical indication for caesarean section is failure to progress during labour. Birthing Balls have been shown to quicken the progression of labour, theoretically reducing caesarean sections with those with epidurals.What do the results of the study add? Several studies have demonstrated a reduced duration of first and second stage of labour among women with epidural anaesthesia, but the existing literature is limited, and interpretation of results may be restricted by generalizability and inherent study biases. The objective of this article is to review existing literature and highlight the potential clinical utility of birthing balls in current obstetric practice.What are the implications of these findings for clinical practice and further research? Use of birthing balls has been advocated to decrease labouring time and therefore reduce progression to caesarean section. Larger studies or meta-analysis would be required to confirm potential benefits of birthing ball use.

The use of visual distraction to improve the tolerability of flexible laryngoscopy.

Flexible laryngoscopy is a commonly performed procedure in otolaryngology. Although this procedure is not considered painful, many patients describe it as uncomfortable. This study investigated the role of visual distraction as a form of pain relief during flexible laryngoscopy. The study included patients undergoing flexible laryngoscopy at the University Hospital Southampton. Patients were self-allocated to one of four groups: with or without co-phenylcaine anaesthetic spray; and with and without visual distraction. Visual distraction involved the patient watching the procedure concurrently with the clinician, via a video monitor. Pre- and post-procedural discomfort was assessed using a visual analogue scale. The use of topical anaesthetic spray was not associated with significantly reduced discomfort scores (p > 0.05). Discomfort scores were significantly reduced in the visual distraction groups (p = 0.04), irrespective of the use of topical anaesthetic spray. This small study showed that visual distraction should be considered as a simple and cost-effective alternative to local anaesthetic for flexible laryngoscopy.

Epidural versus non-epidural or no analgesia for pain management in labour.

Epidural versus non-epidural or no analgesia for pain management in labour.

To study the outcomes of posterior decompression and fixation of tuberculosis of dorsolumbar spine

Introduction: Spinal TB generally starts in the vertebral bodies and the intervertebral discs and is thus called “spondylodiscitis”. It is not only important due to the high prevalence but also because upto 30% of cases develop serious neurological sequelae from compression of the spinal cord, such as para paresis and paraplegia. Although clinical and radiological findings are clear in tuberculosis of the spine, making an early and definite diagnosis is not yet easy, because disease progression is slow and insidious. If there are no complications and if the lesion is limited to the vertebrae, anti-tubercular chemotherapy can treat tuberculosis​ ​. However, with proper indications, surgical procedures are superior in the prevention of neurological deterioration, maintenance of stability, prevention of deformity, early recovery and early mobilization. Tubercular kyphosis is an unstable lesion that tends to progress at least until there is a sound body fusion anteriorly. The wide lesions, abscess formations, sinuses, vertebral deformities and neurological deficits due to spinal tuberculosis should be treated surgically. To date, there are several surgical treatment methods in the literature. Nowadays, tuberculous spine treatment and management has greatly evolved. Aim: To study the results of only posterior decompression and fixation in dorsolumbar tuberculosis spine in view of neurological status, amount of fusion, amount of correction of kyphotic deformity and life style status over the period of time. Materials and Methods: 60 patients were taken in the study initially but out of them 10 did not come for regular follow up. So study consisted of 50 patients. All patients (n=50) who were included in the study had tuberculosis of spine at dorsal and/or lumbar with or without neurological deficit and with or without deformity.All of 50 patients were managed by only posterior decompression and fixation. We studied the cases for development of deformity at dorsal and lumbar spine treated by posterior decompression and fixation and their neurological status according to GERTZBEIN GRADING​​, rate of fusion according to BRIDWELL SCORE​, pain status by DENNIS PAIN SCALE​ and functional ability according to DENNIS WORK SCALE​ and final outcome was assessed according to ​SEYBOLD AND BAYLEY SCALE. Neurological function on admission was graded according to Frankle et al​. Results and Discussion: In the current series of 50 patient’s posterior instrumentation performed to decrease and stabilize the kyphotic unstable segment. Functional outcome was significantly better in posteriorly fixed group of patients with average score being 14.66 (good) according to Seybold and Bayley score. Better targeting of the disease focus with removal of disease focus, possible posterior reconstruction, rapid healing, added stability and better fusion, which all fulfilled by the posterior fixation and decompression and has the better functional outcome. Conclusion: From the present study, we concluded that functional outcome is better according to Seybold and Bayley Scale in form of pain relief, work performance, fusion and neurological outcome after posterior decompression and fixation.Posterior fixation is safe and helps in early mobilization and rehabilitation.

Requests for cesarean deliveries: The politics of labor pain and pain relief in Shanghai, China

Cesarean section rates have risen dramatically in China within the past 25 years, particularly driven by non-medical factors and maternal requests. One major reason women request cesareans is the fear of labor pain, in a country where a minority of women are given any form of pain relief during labor. Drawing upon ethnographic fieldwork and in-depth interviews with 26 postpartum women and 8 providers at a Shanghai district hospital in June and July of 2015, this article elucidates how perceptions of labor pain and the environment of pain relief constructs the cesarean on maternal request. In particular, many women feared labor pain and, in a context without effective pharmacological pain relief or social support during labor, they came to view cesarean sections as a way to negotiate their labor pain. In some cases, women would request cesarean sections during labor as an expression of their pain and a call for a response to their suffering. However, physicians, under recent state policy, deny such requests, particularly as they do not view pain as a reasonable indication for a cesarean birth. This disconnect leads to a mismatch in goals for the experience of birth. To reduce unnecessary C-sections, policy makers should instead address the lack of pain relief during childbirth and develop other means of improving the childbirth experience that may relieve maternal anxiety, such as allowing family members to support the laboring woman and integrating a midwifery model for low-risk births within China's maternal-services system.